CMS releases 200 new Medicare residency slots

Modern Healthcare – Friday, November 22, 2024
By Bridget Early

The Centers for Medicare and Medicaid Services is focusing on primary care and mental healthcare in its latest Medicare residency payments.

CMS on Thursday released 200 new graduate medical education residency slots, many of which are set aside for students looking to pursue careers in primary care and psychiatry.

“These residency positions are crucial to helping America’s academic health systems and other teaching hospitals invest in more physician training, increase access to care, and better serve patients nationwide,” Dr. Jonathan Jaffery, chief healthcare officer for the Association of American Medical Colleges, said in a news release.

AAMC projects that the U.S. will face a shortage of up to 86,000 physicians by 2036. Medicare is the largest single funding source for physician residency programs, paying $16.2 billion for slots in 2020, according to the Congressional Research Service.

But hospitals and groups such as AAMC and the American Medical Association have raised concerns about a scarcity of slots and the formulas CMS uses to calculate payments.

The new slots are part of Congress’ first increases to GME funding since 1997. Lawmakers allocated funding for a total of 1,200 new slots in two recent end-of-year spending packages, the Consolidated Appropriations Act of 2021 and the CAA of 2023.

The latest set of slots, which go into effect in July 2025, includes positions at 109 teaching hospitals across 33 states, according to a news release from AAMC. About 70% of total slots in this round were set aside for either psychiatry or primary care.

New York received a total of 16 new slots spread across as many teaching hospitals, the most of any state. Six of those were for psychiatry, according to CMS data. New York was followed by Illinois and Arizona, which each received a total of nine new slots.

To qualify for a slot, hospitals must meet at least one of four criteria: they need to be in a rural area, be training a number of residents that exceeds their current GME slots, be in a state with new medical schools or branch campuses, or be in a Health Professional Shortage Area.

Under federal law, at least 10% of new slots must go to hospitals in each of those four categories. No single hospital can receive more than 25 slots, according to the CMS website.

“Because our hospitals play a central role in preparing healthcare professionals to care for underserved populations, we believe it is important for CMS to target additional slots to essential hospitals to reach more disadvantaged patients and advance the agency’s equity goals,” Beth Feldpush, senior vice president of policy and advocacy for America’s Essential Hospitals, said in an email. The association represents the nation’s safety-net hospitals.

The latest release — CMS’ third annual distribution — means the federal government has now distributed half of the new slots funded in 2021 and 2023.

But stakeholders are still pushing Congress to increase funding to help meet rising demand for care and shifting demographic factors, such as a growing and aging population and a physician workforce that is also aging.

“Addressing the primary care physician shortage will require a targeted approach,” the American Academy of Family Physicians said in an email. “That’s why the AAFP appreciates CMS’ continued distribution of new Medicare GME slots, with almost half going to primary care specialties. This is a critical step toward advancing access to primary care in underserved communities and will help address the primary care physician shortage.”

To help further increase slots and reduce workforce shortages, AMA, AAMC and other industry organizations want Congress to enact the Resident Physician Shortage Reduction Act of 2023, a bipartisan bill that would add 14,000 new slots over seven years. The bill is sponsored by Reps. Terri Sewell (D-Ala.) and Brian Fitzpatrick (R-Pa.) and has nearly 200 cosponsors.

“Funding for these slots has not kept pace with the nation’s healthcare needs and increase in medical student enrollment,” Dr. Bruce Scott, president of the AMA, said in an email. “While this announcement is a welcome development, we urge Congress to pass additional funding and residency slots to ensure we are prepared for the healthcare needs of tomorrow.”

Medical students filled a record number of residency positions this year, according to Match Day results released in March by the National Resident Matching Program.

For teaching hospitals that don’t receive federal funding, some choose to offset the expense of training new physician residents themselves rather than face workforce shortages, the Government Accountability Organization found in 2021.

AAMC says the new slots will help address physician shortages and grow the workforce.

“Medical school enrollment has continued to grow, but a commensurate increase in residency positions is necessary to help ensure that there are enough opportunities for medical school graduates to complete their training and practice independently,” Dr. David Skorton, AAMC president and CEO, said in a news release.

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